Introduction
Everyone talks about heart health but few know exactly which strategies to incorporate to set up their heart-health for long term success. Let's start with some statistics. The heart beats over 100,000 times a day pumping 5 litres of blood per minute. That's a staggering 7000 litres of blood being moved around your body every day. This is an organ that deserves your undivided attention when it comes to preventive care.
Now let's discuss how things can go wrong. Most heart attacks and strokes don’t come out of nowhere - risk factors develop silently over years, often a decade or more, before the first symptom appears. Many cardiovascular risk factors develop silently over years, long before symptoms appear. The encouraging news is that a substantial proportion of cardiovascular disease is associated with modifiable risk factors, including high blood pressure, raised cholesterol, smoking, diabetes and physical inactivity. Addressing these factors can significantly reduce the risk of heart attack and stroke.
At Emerald, we believe that heart disease isn't an inevitability of ageing; it is a process that can be identified and intercepted long before it reaches a crisis point.
Know Your Numbers
High blood pressure, raised cholesterol and abnormal blood glucose can develop without noticeable symptoms. Monitoring these measurements can help identify cardiovascular risk factors early, allowing you to take action before complications develop. However, blood tests are only one part of assessing your cardiovascular health. Your age, family history, smoking status and other medical conditions are equally important when determining your overall risk.
Blood Pressure: High blood pressure is one of the leading modifiable risk factors for cardiovascular disease and often causes no symptoms. Hypertension is generally diagnosed when clinic readings are 140/90 mmHg or higher and average home or ambulatory readings are 135/85 mmHg or higher. Regular monitoring can help identify elevated blood pressure before it causes complications.
Cholesterol Profile: Raised LDL cholesterol contributes to the development of fatty deposits within artery walls, increasing the risk of heart attack and stroke. A standard lipid profile measures total cholesterol, HDL cholesterol, non-HDL cholesterol and triglycerides, with LDL cholesterol also commonly reported. Additional measurements, such as apolipoprotein B (ApoB), can provide further information about the number of cholesterol-carrying particles associated with cardiovascular risk, particularly when standard lipid measurements may underestimate that risk.
Metabolic Markers: Fasting glucose and HbA1c measurements can help identify prediabetes and diabetes, both of which are associated with increased cardiovascular risk. Persistently elevated blood glucose can contribute to blood vessel damage over time, increasing the likelihood of complications such as coronary artery disease and stroke. Identifying abnormalities early provides an opportunity to address lifestyle factors and, where necessary, introduce treatment.
We recommend everyone get the above 3 tests as a minimum to understand their heart health today and set out a plan for tomorrow. You can get all the above tested and more using the Emerald comprehensive health assessment, available at 50+ clinics nationwide.
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Can a scan help assess my heart health?
Yes and no. For some, a scan such as a Coronary Artery Calcium (CAC) score can be a game-changer. It reclassifies your risk, helping doctors decide whether preventive medications like statins are a necessary clinical backstop or if lifestyle optimisation remains the primary focus.
It does have drawbacks, however. Specifically, the scanner is blind to "soft" (non-calcified) plaque. This is the early-stage, fatty buildup that hasn’t yet mineralised. Because soft plaque is more unstable and prone to rupture than hardened calcium, a score of zero—while highly reassuring—isn't an absolute guarantee of a clean bill of health, particularly in younger patients.
Despite this, the CAC score is an invaluable "tie-breaker" for those in the intermediate-risk category. It is particularly effective for:
Borderline Cases: If your cholesterol is slightly elevated but your lifestyle is excellent, a CAC score reveals whether your arteries are actually being impacted.
Positive Family History: If heart disease runs in your family, this test identifies if you have inherited a "fast-forward" button on arterial ageing.
Decisions on Statins: For those hesitant about medication, seeing a physical measurement of plaque provides the objective evidence needed to move from guesswork to a confident clinical strategy.
5 Evidence based ways to protect your heart
The most effective cardiovascular prevention strategies are often straightforward. Although genetics and age influence your risk, there are several factors you can change to improve your long-term heart health.
Stay physically active: Aim for at least 150 minutes of moderate-intensity aerobic activity each week, alongside regular strength training.
Follow a heart-healthy diet: Mediterranean-style diets, rich in vegetables, whole grains, legumes, nuts and unsaturated fats, are associated with better cardiovascular outcomes. Reducing salt and saturated fat intake can also improve blood pressure and cholesterol.
Avoid smoking: Stopping smoking is one of the most effective ways to reduce cardiovascular risk, with benefits beginning soon after quitting.
Maintain a healthy weight: Where appropriate, reducing excess body weight can improve blood pressure, cholesterol and blood glucose regulation.
Manage existing risk factors: If you have hypertension, diabetes or elevated cholesterol, lifestyle changes may need to be combined with medication. Treatments such as statins and antihypertensives have strong evidence for reducing cardiovascular events in appropriately selected patients.
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Signs You Shouldn’t Ignore
Cardiovascular disease can develop silently over many years, but certain symptoms may indicate an underlying problem with your heart or circulation. Recognising these signs early can help prevent more serious complications.
Chest pain or discomfort: Pressure, tightness or pain in the chest, particularly during physical activity, may indicate reduced blood flow to the heart. Sudden or persistent chest pain, especially if it spreads to the arm, jaw or back, may be a sign of a heart attack and requires emergency medical attention.
Unexplained breathlessness: Becoming unusually short of breath during activities you previously managed comfortably, or experiencing breathlessness when lying flat, can sometimes indicate underlying heart disease or heart failure.
Reduced exercise tolerance: A noticeable decline in your ability to exercise or carry out everyday activities, particularly when accompanied by fatigue or breathlessness, may be an early sign of cardiovascular disease.
Swelling in the ankles or legs: Persistent swelling, particularly when accompanied by breathlessness or fatigue, can indicate fluid retention associated with heart failure, although there are many other possible causes.
Erectile dysfunction: In men, erectile dysfunction can sometimes be an early indicator of cardiovascular disease because the smaller arteries supplying the penis may be affected by atherosclerosis before symptoms develop elsewhere. However, erectile dysfunction has several possible causes and does not necessarily indicate heart disease.
Many of these symptoms have causes unrelated to cardiovascular disease. However, new, persistent or worsening symptoms should be assessed by a healthcare professional. If you experience symptoms suggestive of a heart attack, call 999 immediately.
References
Visseren FLJ, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42:3227–3337. Full text.
NICE. Cardiovascular disease: risk assessment and reduction, including lipid modification. NG238. 2023. Guideline.
NICE. Hypertension in adults: diagnosis and management. NG136. 2019, updated. Guideline.
Arnett DK, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Circulation. 2019;140:e596–e646. Full text.
Estruch R, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. 2018;378:e34. Full text.
NICE. Chest pain of recent onset: assessment and diagnosis. CG95. 2010, updated. Guideline.
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